The Relationship between Waist Circumference and Cecal Intubation Time in Women.

OBJECTIVE: To investigate the relationship between waist circumference and cecal intubation time (CIT) in female subjects during colonoscopy. STUDY DESIGN: A descriptive study. PLACE AND DURATION OF STUDY: Department of General Surgery, Kanuni Training and Research Hospital, Turkey, from January to September 2016. METHODOLOGY: This study included 61 female subjects who underwent colonoscopy in our clinic. The colonoscopies were performed by a single surgeon. The waist circumferences of all subjects were measured before the procedure with the technique recommended by the WHO. In colonoscopy, the cecal intubation time was recorded for each subject. The results were evaluated statistically and p <0.05 was considered significant. RESULTS: The mean waist circumference was 100.6 ±19.0 cm. The mean cecal intubation time was 9.0 ±2.7 minutes. A strong statistically significant negative correlation was found between waist circumference and cecal intubation time (r = -0.689, p <0.001). CONCLUSION: The cecal intubation time was found to be significantly shorter in the female subjects with larger waist circumferences.

Comparison of limberg flap and oval flap techniques in sacrococcygeal pilonidal sinus disease surgery.

OBJECTIVE: Although many surgical techniques have been described for treatment of pilonidal sinus disease (PSD), the ideal treatment method remains controversial. The purpose of this study was to compare Limberg flap and oval flap techniques in patients with PSD. MATERIAL AND METHODS: Patients diagnosed with PSD who underwent surgery using either the Limberg flap or oval flap technique between January 2012 and January 2016 at the general surgery outpatient clinic were retrospectively reviewed from the database of our hospital; 142 patients (124 males and 18 females) were invited for examination. The demographic characteristics of the patients such as age and gender, hospital stays, seroma occurrence, surgical site infections, wound dehiscence, flap necrosis, loss of sensation, and recurrences were evaluated based on the information obtained from the database and from physical examinations as well as questioning of the patients. The results were statistically compared, and a p value of <0.05 was considered significant. RESULTS: The mean age of the patients was 27.5±7.8 years in the Limberg flap group and 26.5±7.2 years in the oval flap group. No significant difference was found between the two groups regarding patients' mean age; gender distribution; postoperative hospital stay; recurrence; and complications, such as seroma, infection, wound dehiscence, and loss of sensation. Flap necrosis was not observed in any of the patients. CONCLUSION: The Limberg flap and oval flap procedures both involve minimum morbidity and short hospital stay because they were not superior to one another regarding treatment effectiveness, complications, and recurrence in the pilonidal sinus surgery.

Effects of body mass index on cecal intubation time in women.

OBJECTIVE: During colonoscopy, cecal intubation time is prolonged with increase in difficulty of the procedure. Cecal intubation time may be affected by age, gender, and body structure. We investigated the relationship between body mass index and cecal intubation time in women. MATERIAL AND METHODS: This prospective study included 61 women who underwent colonoscopy in the endoscopy unit of the General Surgery Clinic in Trabzon Kanuni Training and Research Hospital between January 2016 and September 2016. The colonoscopies were performed by a single surgeon. The height and weight of all the participants were measured, and their body mass index values were calculated before the procedure. The timer was activated as soon as entry was made from the anal region with colonoscope and stopped when the cecum was reached. The cecal intubation time was recorded for each subject. The results were evaluated statistically, and p<0.05 was considered to be significant. RESULTS: The mean body mass index was 29.6±6.8 kg/m2. The median cecal intubation time was 4 min. (minimum 2 min; maximum 8 min). A significantly strong positive correlation was found between body mass index and cecal intubation time (r:-0.891, p<0.001). CONCLUSION: Cecal intubation time was found to be shorter in women whose body mass index values were high. This outcome may help to eliminate the "the colonoscopy will be difficult" preconception, which is common among endoscopists with regard to the colonoscopies for obese female patients.

A proposed staging system for chronic symptomatic pilonidal sinus disease and results in patients treated with stage-based approach.

BACKGROUND: Although there are many therapeutic options to manage patients with sacrococcygeal pilonidal sinus disease, there remains controversy over a gold standard method for treating such patients. Most studies regarding sacrococcygeal pilonidal sinus, collected patients in a single pool, and single modality was performed to all patients so far. Staging according to the progressive nature of disease and comparisons of stage-based treatment approaches are yet to be conducted. This study aimed to define a staging system and to evaluate outcomes with the use of stage-based treatment approach. METHODS: The collected data of patients who underwent surgery for the treatment of pilonidal sinus disease prior to June 2011 were analyzed. Following this analysis, a staging system was defined based on morphological extent of disease (stage I to stage IV for primary disease, and stage R for recurrent disease). Specific surgical technique was used for each stage. Between June 2011 and December 2014, 367 patients were operated based on proposed staging system and treatment algorithm. Demographics, perioperative data, short-term and long-term outcomes were evaluated according to the disease stage. RESULTS: For all patients, the median length of hospital stay was 1 (range, 0-4) day. Primary healing without any wound complications was achieved in 320 (87.2%) patients. The median time to functional recovery was 10 (range, 2-35) days and for wound healing was 12 (range, 10-55) days. Disease recurrence was identified in six (1.6%) patients within the median follow-up period of 29 (range, 5-47) months. The outcomes of each stage were evaluated separately. CONCLUSIONS: We believe that the proposed staging system and stage-based treatment approach, which need further validation, will have an efficacy in the treatment of chronic pilonidal sinus disease and will contribute to the development of more appropriate individualized management approaches. Moreover, the use of this staging system will likely facilitate sharing and comparing more specific clinical data from future studies. TRIAL REGISTRATION: NCT02712970 (ClinicalTrials.gov/09.03.2016).

Is non-operative management feasible for splenic injury due to colonoscopy?

Colonoscopy is a widely used diagnostic and therapeutic procedure. While it is a relatively safe procedure, there is a risk of some complications. Splenic injury after colonoscopy is a very rare but a life-threatening complication; around 105 cases have been reported in the literature so far. Owing to the rarity of this complication, no management standards were defined. In the literature, most of the patients were managed with operative intervention and less frequently with observation. We report a case of splenic injury and massive hemoperitoneum due to colonoscopy treated non-operatively.

A rare and forgotten diagnosis of gastrointestinal bleeding: primary aortoduodenal fistula.

Upper gastrointestinal (UGI) bleeding is a common medical condition among adults. Bleeding is mainly caused by the gastric or proximal duodenum, but rarely by the distal duodenum. Aortoduodenal fistula is one of the causes of UGI bleeding that results in a life-threatening condition if not treated properly. It is commonly observed in patients who have undergone previous aortic surgery and rarely occurs in patients without a history of aortic surgery. Diagnosis of aortoenteric fistula is difficult unless there is a high level of clinical suspicion. In this article, we aim to present a patient with aortoduodenal fistula and discuss the clinical presentation, as well as the diagnostic and therapeutic options of this disease.

The protective effects of glutamine on radiation-induced diarrhea.

INTRODUCTION: Glutamine is a neutral amino acid that is used by rapidly dividing cells such as erythrocytes, lymphocytes, and fibroblasts. It is also the substrate of glutathione synthesis. In normal metabolic rates, glutamine is an amino acid synthesized endogenously, but in high metabolic conditions such as cancer, it must be taken exogenously. Animal studies strongly demonstrate that glutamine protects both the upper and lower gastrointestinal tract mucosa from the effects of chemotherapy, radiotherapy, or other causes of injury. In this study, we investigated the protective effect of glutamine on radiation-induced diarrhea. PATIENTS AND METHOD: The patients were divided into glutamine-treated and placebo groups. In the glutamine-treated group, 15 g of oral glutamine was administered three times daily. The patients were evaluated for diarrhea grade according to the National Cancer Institute Common Toxicity Criteria version 3.0, (Table 1), need for loperamide use, need for supportive parenteral therapy, and treatment breaks due to diarrhea. RESULTS: There was no difference in overall diarrhea incidence when the two groups were compared. When diarrhea grade was evaluated, none of the patients in the glutamine-treated group had grade 3-4 diarrhea, but in the placebo group, grade 3-4 diarrhea was seen in 69 % of the patients. In the placebo-treated group, patients requiring loperamide and parenteral supportive therapy were 39 and 92 %, respectively. There was no treatment break in glutamine-treated patients. CONCLUSION: Glutamine may have protective effect on radiation-induced severe diarrhea.

Small Bowel Intussusception due to Metastasized Sarcomatoid Carcinoma of the Lung: A Rare Cause of Intestinal Obstruction in Adults.

Although small bowel intussusception is one of the most common abdominal emergencies in childhood, it is rare in adults and usually occurs as a result of an underlying pathology. Sarcomatoid carcinoma, a very rare subtype of lung cancer, rarely metastasizes to small bowel and causes complications. In this paper, we aim to describe a patient with small bowel intussusception caused by an isolated small bowel metastasis of the sarcomatoid carcinoma of the lung by reviewing the literature.

The effects of pentoxifylline on liver regeneration after portal vein ligation in rats.

AIM: To determine the effects of pentoxifylline, a methyl xanthine derivative on hepatic cell production of uninterferred lobe after portal vein branch ligation. METHODS: Sixty-six rats were randomly allocated into 9 groups with 8 rats in PVL groups and 6 rats in sham operation groups. The portal branches of the median and the lateral liver lobes, corresponding to approximately 70% of the liver volume were ligated in the PVL groups. The control group received 0.9% NaCl solution. The rats in the treatment groups received pentoxifylline at the dose of 50 mg/kg/dy. After 1, 2, 4 days of portal vein ligation in both PVL and PVNL lobes the levels of adenine nucleotides were determined and flowcytometric analysis of cell cycles were performed. RESULTS: On the first day of portal branch ligation energy charge was significantly lower, in pentoxifylline treated group comparing to pentoxifylline untreated group, both in PVL and PVNL lobes (P<0.05). Proliferative indexes were 0.38 and 0.29 in pentoxifylline treated and pentoxifylline untreated PVNL lobes respectively (P<0.05). CONCLUSION: Pentoxifylline treatment resulted in an increase of percentage of calls entering mitosis phase on the first day after PVL, somehow accelerating the regeneration process.

Multiple dose-activated charcoal as a cause of acute appendicitis.

We presented a case of a 55-year-old woman who intentionally ingested an unknown amount of carbosulfan, a carbamate insecticide. On admission, her clinical findings were coma, pinpoint pupils, hypersalivation, respiratory failure, bradycardia, and hypotension. Hertrachea was intubated after suction of secretions, and atropine was administered intravenously. After gastric lavage, multiple doses of activated charcoal were instilled through the nasogastric tube over five days (total doses of 840 g). On the fourteenth day, she developed right-lower quadrant abdominal pain, anorexia, nausea, and vomiting, and she underwent an appendectomy. On pathologic examination of the specimen, particles of activated charcoal were seen within the dilated part of the appendiculer lumen. The patient was discharged from the hospital after antidepressant therapy at the psychiatry clinic. This case documents that multiple doses of activated charcoal may be associated with acute appendicitis.

The effects of somatostatin on the microperfusion of the pancreas during acute necrotizing pancreatitis in rats.

BACKGROUND/AIMS: Autodigestion and impairment of microcirculation of the pancreas play an important role in the pathogenesis of acute pancreatitis. Somatostatin with the reducing effect on the hepato-splanchnic blood flow decreases exocrine pancreatic secretion. Microcirculatory changes are central to the pathogenesis of acute pancreatitis. However, little is known about the effects of somatostatin on the pancreatic tissue oxygen pressure and acinar cell injury during acute pancreatitis. The aim was to evaluate somatostatin by measuring its effect on the pancreatic tissue oxygen pressure and acinar injury in acute pancreatitis. METHODOLOGY: Acute necrotizing pancreatitis was induced in rats by standardized intraductal bile acid infusion and cerulein hyperstimulation. Serum trypsinogen activation peptide was measured to verify comparable disease severity. After the induction of acute necrotizing pancreatitis, animals randomly received either ringer lactate or somatostatin. Monitoring included cardiorespiratory parameters, hematocrit, amylase, pancreatic tissue oxygen pressure, and trypsinogen activation peptide levels. At the end of the experiments the pancreas was removed for evaluation of acinar cell injury. RESULTS: The two study groups were comparable with regard to mean arterial pressure, heart rate, arterial blood gases, hematocrit, and serum amylase. The induction of pancreatitis resulted in the significant decrease of pancreatic tissue oxygen pressure in both groups. The use of somatostatin did not increase pancreatic tissue oxygen pressure. There were no significant differences in plasma trypsinogen activation peptide and serum amylase levels in the animals of two treatment groups. Only somatostatin decreased pancreatic damage significantly. CONCLUSIONS: The use of somatostatin did not improve pancreatic microcirculation or trypsinogen activation peptide level in acute necrotizing pancreatitis; however, it reduced pancreatic damage. Therefore, it has a limited value in the treatment of the acute pancreatitis.

The effects of prostaglandin E1 on the microperfusion of the pancreas during acute necrotizing pancreatitis in rats.

BACKGROUND/AIMS: In this study we investigated the effects of prostaglandin E1 on the microperfusion of the pancreas during acute necrotizing pancreatitis in rats. METHODOLOGY: Acute necrotizing pancreatitis was induced in rats by standardized intraductal bile acid infusion and cerulein hyperstimulation. Serum trypsinogen activation peptides were measured to verify comparable disease severity. After the induction of acute pancreatitis, animals randomly received either ringer lactate or prostaglandin E1. Monitoring included cardiorespiratory parameters, hematocrit, pancreatic oxygen tissue oxygen pressure, serum amylase and trypsinogen activation peptides. At the end of experiments pancreas was removed for evaluation of acinar cell injury. RESULTS: The two study groups were comparable with regard to mean arterial pressure, heart rate, arterial blood gases, hematocrit, and serum amylase. The induction of pancreatitis resulted in the significant decrease of pancreatic tissue oxygen pressure. In both groups the use of prostaglandin E1 did not change pancreatic tissue oxygen pressure despite of stable cardiorespiratory parameters, and serum amylase activity. Prostaglandin E1 decreased pancreatic damage and serum trypsinogen activation peptide level significantly. CONCLUSIONS: These results suggest that prostaglandin E1 had no effects on the improvement of microcirculation of pancreas, and had beneficial effects on the course of acute necrotizing pancreatitis.